[Federal Register Volume 68, Number 80 (Friday, April 25, 2003)]
[Notices]
[Pages 20391-20393]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-9496]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-2182-PN]


Medicare and Medicaid Programs; Application by the Community 
Health Accreditation Program (CHAP) for Continued Approval of Deeming 
Authority for Hospices

AGENCY: Centers for Medicare & Medicaid Services, HHS.

ACTION: Proposed notice.

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SUMMARY: This proposed notice acknowledges the receipt of an 
application from the Community Health Accreditation Program (CHAP) for 
continued recognition as a national accreditation program for hospice 
facilities that wish to participate in the Medicare or Medicaid 
programs. Section 1865(b)(3)(A) of the Social Security Act (the Act) 
requires that within 60 days of receipt of an organization's complete 
application, we publish a notice that identifies the national 
accrediting body making the request, describes the nature of the 
request, and provides at least a 30-day public comment period.

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DATES: We will consider comments if we receive them at the appropriate 
address, as provided below, no later than 5 p.m. on May 27, 2003.

ADDRESSES: In commenting, please refer to file code CMS-2182-PN. Due to 
staff and resource limitations, we cannot accept comments by facsimile 
(fax). Mail written comments (one original and three copies) to the 
following address: Centers for Medicare and Medicaid Services, 
Department of Health and Human Services, Attention: CMS-2182-PN, P.O. 
Box 8013, Baltimore, MD 21244-8013.
    Please allow sufficient time for mailed comments to be received in 
the event of delivery delays.
    If you prefer, you may deliver (by hand or courier) your written 
comments (one original and three copies) to one of the following 
addresses: Room 443-G, Hubert H. Humphrey (HHH) Building, 200 
Independence Avenue, SW., Washington, DC 20201, or Room C5-14-03, 7500 
Security Boulevard, Baltimore, MD 21244-1850.
    (Because access to the interior of the HHH Building is not readily 
available to persons without Federal Government identification, 
commenters are encouraged to leave their comments in the CMS drop slots 
located in the main lobby of the building. A stamp-in clock is 
available for persons wishing to retain a proof of filing by stamping 
in and retaining an extra copy of the comments being filed.)
    Comments mailed to the above addresses indicated as appropriate for 
hand or courier delivery may be delayed and received too late for us to 
consider them.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT:  Cindy Melanson, (410) 785-0310.

SUPPLEMENTARY INFORMATION: Inspection of Public Comments: Comments 
received timely will be available for public inspection as they are 
received, generally beginning approximately 3 weeks after publication 
of a document, at the headquarters of the Centers of Medicare & 
Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244, 
Monday through Friday of each week from 8:30 a.m. to 4 p.m. Top 
schedule an appointment to view public comments, phone (410) 786-7195.

I. Background

    Under the Medicare program, eligible beneficiaries may receive 
covered services in a hospice, provided certain requirements are met. 
Section 1861(dd) of the Social Security Act (the Act) establishes 
distinct criteria for facilities seeking designation as a hospice 
provider. Provider agreement regulations are located in 42 CFR part 
489, and regulations pertaining to activities relating to the survey 
and certification of facilities are located in 42 CFR part 488. The 
regulations at 42 CFR part 418 specify the conditions that a hospice 
facility must meet in order to participate in the Medicare program, the 
scope of covered services, and the conditions for Medicare payment for 
hospice care. Section 1905(O)(1)(A) of the Act generally extends their 
requirements to payments for hospice services under the Medicaid 
program.
    Generally, in order to enter into an agreement, a hospice facility 
must first be certified by a State survey agency as complying with the 
conditions or requirements set forth in part 418 of our regulations. 
Then, the hospice facility is subject to regular surveys by a State 
survey agency to determine whether it continues to meet these 
requirements. There is an alternate, however to surveys by State 
agencies.
    Section 1865(b)(1) of the Act provides that, if a provider entity 
demonstrates through accreditation by an approved national 
accreditation organization that all applicable Medicare conditions are 
met or exceeded, we would ``deem'' those provider entities as having 
met the requirements. Accreditation by an accreditation organization is 
voluntary and is not required for Medicare participation.
    If an accreditation organization is recognized by the Secretary as 
having standards for accreditation that meet or exceed Medicare 
requirements, any provider entity accredited by the national 
accrediting body's approved program would be deemed to meet the 
Medicare conditions. A national accreditation organization applying for 
approval of deeming authority under part 486, subpart A must provide us 
with reasonable assurance that the accreditation organization requires 
the accredited provider entities to meet requirements that are at least 
as stringent as the Medicare conditions. Our regulations concerning 
reapproval of accrediting organizations are set forth at Sec.  488.4 
and Sec.  488.8(d)(3). The regulations at Sec.  488.8(d)(3) require 
accreditation organizations to reapply for continued approval of 
deeming authority every 6 years or sooner as determined by us. The 
Community Health Accreditation Program's (CHAP's) term of approval as a 
recognized accreditation program for hospice facilities expires 
November 20, 2003.

II. Approval of Deeming Organizations

    Section 1965(b)(2) of the Act and our regulations at Sec.  488.8(a) 
require that our findings concerning review and reapproval of a 
national accrediting organization's requirements consider, among other 
factors, the reapplying accreditation organization's: Requirements for 
accreditation; survey procedures; resources for conducting required 
surveys; capacity to furnish information to use in enforcement 
activities; monitoring procedures for provider entities found not in 
compliance with the conditions or requirements; and ability to provide 
us with the necessary data for validation.
    Section 1865(b)(3)(A) of the Act further requires that we publish, 
within 60 days of receipt of an accreditation organization's complete 
application, a notice identifying the national accreditation body 
making the request, describing the nature of the request, and providing 
at least a 30-day public comment period. In addition, we must publish a 
notice in the Federal Register or our approval or denial of the 
application within 210 days from the receipt of the application.
    The purpose of this proposed notice is to inform the public of our 
consideration of CHAP's request for approval of continued deeming 
authority for hospice facilities. This notice also solicits public 
comment on whether CHAP requirements meet or exceed the Medicare 
conditions for participation for hospice facilities.

III. Evaluation of Deeming Authority Request

    On February 21, 2003, CHAP submitted all the necessary materials to 
enable us to make a determination concerning its request for reapproval 
as a deeming organization for hospice facilities. Under section 
1865(b)(2) of the Act and our regulations at Sec.  488.8 (Federal 
review of accreditation organizations), our review and evaluation of 
CHAP will be conducted in accordance with, but not necessarily limited 
to, the following factors:
    [sbull] The equivalency of CHAP standards for hospice care as 
compared with our comparable hospice conditions of participation.
    [sbull] CHAP's survey process to determine the following:

--The composition of the survey team, surveyor qualifications, and the 
ability of the organization to provide continuing surveyor training.
--The comparability of CHAP processes to that of State agencies, 
including survey frequency, and the ability to investigate and respond 
appropriately

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to complaints against accredited facilities.
--CHAP's processes and procedures for monitoring providers or suppliers 
found out of compliance with CHAP program requirements. These 
monitoring procedures are used only when CHAP identifies noncompliance. 
If noncompliance is identified through validation reviews, the survey 
agency monitors corrections as specified at Sec.  488.7(d).
--CHAP's capacity to report deficiencies to the surveyed facilities and 
respond to the facility's plan of correction in a timely manner.
--CHAP capacity to provide us with electronic data in ASCII comparable 
code, and reports necessary for effective validation and assessment of 
the organization's survey process.
--The adequacy of CHAP's staff and other resources, and its financial 
viability.
--CHAP's capacity to fund required surveys.
--CHAP's policies with respect to whether surveys are announced or 
unannounced.
--CHAP's agreement to provide us with a copy of the most current 
accreditation survey together with any other information relate to the 
survey as we may require (including corrective action plans).

IV. Response to Public Comments and Notice Upon Completion of 
Evaluation

    Due to the large number of items of correspondence we normally 
receive a Federal Register documents published for comment, we are not 
able to acknowledge or respond to them individually. We will consider 
all comments we receive by the date and time specified in the DATES 
section of this preamble and will respond to the public comments in the 
preamble to that document.
    Upon completion of our evaluation, including evaluation of comments 
received as a result of this notice, we will publish a final notice in 
the Federal Register announcing the result of our evaluation.
    In accordance with the provisions of Executive Order 12866, this 
notice was not reviewed by the Office of Management and Budget.

    Authority: Section 1965 of the Social Security Act (42 U.S.C. 
1395bb) (Catalog of Federal Domestic Assistance Program No. 93.778, 
Medical Assistance Program; No. 93.773 Medicare--Hospital Insurance 
Program; and No. 93.774, Medicare--Supplementary Medical Insurance 
Program)

    Dated: April 8, 2003.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 03-9496 Filed 4-24-03; 8:45 am]
BILLING CODE 4120-01-M